Part B News Features
Question: We were audited recently for 10 claims where the patients received Durolane, specifically, and all 10 claims were denied for lack of medical necessity. A customer service representative to... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Care management services under Medicare, including transitional care management (TCM) codes 99495-99496, chronic care management (CCM) codes 99437, 99439, 99487, 99489, 99490 and 99491, and principal ... More
Question: We were audited recently for 10 claims where the patients received Durolane, specifically, and all 10 claims were denied for lack of medical necessity. A customer service representative to... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Care management services under Medicare, including transitional care management (TCM) codes 99495-99496, chronic care management (CCM) codes 99437, 99439, 99487, 99489, 99490 and 99491, and principal ... More
Tools
Find the latest list of designated health services (DHS) that are subject to the Stark physician self-referral rule’s restriction on referrals. The new list went into effect Jan. 1, 2026.
Get a head start on revisions to codes in the E/M, cardiovascular, radiology and medicine chapters of the 2026 CPT Manual. The following chart contains the current and revised long descriptors for codes that CMS released in the proposed 2026 Medicare physician fee schedule and intends to assign an active (A) payment status
Benchmark of the Week
Care management services under Medicare, including transitional care management (TCM) codes 99495-99496, chronic care management (CCM) codes 99437, 99439, 99487, 99489, 99490 and 99491, and principal care management (PCM) codes 99424-99427, bounced back in 2024 after a COVID-era malaise (PBN 10/27/25). New 2025 Medicare utilization numbers show that the trend is still up and that denials have stabilized.
Practices that frequently report claims with modifier 25 could be on the short end of a massive redistribution of professional fees in CY 2027. In the balance hangs nearly $900 million in payments, according to analysis from Jiro Health.
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